The study was randomized to 231 patients with KIDGO criteria, grade 2 (SCr doubling or hourly urine volume <0.5, mL/kg lasting more than 12 hours) and AKI (NGAL) >150ng/mL. Early treatment was defined as diagnosis of grade 2, and renal replacement therapy (RRT) was initiated within 8 hours of AKI. Late treatment is defined as the diagnosis of grade 3 AKI, within 12 hours after the start of RRT or without the use of RRT.
The average age of the 231 patients was 67 years, and 146 were males. All 112 patients in the early treatment group received RRT, and 108 patients in the advanced treatment group received RRT.
All patients were followed up for 90 days. The mortality rate in the early treatment group was significantly lower than that in the late treatment group for 90 days. After 90 days of follow-up, the recovery rate of renal function in the early treatment group and the late treatment group was 53.6% and 38.7%, respectively. The median dialysis time was 9 days in the early treatment group and 25 days in the late treatment group. The time of mechanical ventilation was 125.5 days in the early treatment group and 181 days in the late treatment group. The hospital stay was 51 days in the early treatment group and 82 days in the late treatment group.
These results suggest that the incidence of major end points and secondary end points in the early treatment group is significantly better than that in the late treatment group at 90 days. In the study, the median duration of treatment between the two groups was less than 24 hours, but the benefit of the patients was markedly different. Again, we suggest that the timing of dialysis in patients with AKI is critical for patient outcomes.
Recently, however, a multicenter study published by Stephane et al on The New Journal of Medicine showed that early and late RRT did not differ significantly in mortality among AKI patients (England). In contrast, the early treatment group had a higher rate of RRT related complications.
The timing of dialysis in patients with AKI has a significant impact on patient outcomes, length of stay, and medical costs. Research by Zarbock et al suggests that early RRT may benefit AKI patients. However, in specific clinical work, we need to determine the timing of dialysis according to the patient's specific circumstances. It is hoped that with the advent of more relevant randomized controlled trials, more scientific evidence will be available to support our clinical decisions.